Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$66,057.47

Service Code	MSDRG 040
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,057.47
Rate for Payer: Hawaii Medical Service Association Commercial	$66,057.47
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$50,106.03

Service Code	MSDRG 042
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$50,106.03
Rate for Payer: Hawaii Medical Service Association Commercial	$50,106.03
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$24,531.57

Service Code	MSDRG 300
Min. Negotiated Rate	$24,531.57
Max. Negotiated Rate	$24,531.57
Rate for Payer: Hawaii Medical Service Association Commercial	$24,531.57

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$26,024.80

Service Code	MSDRG 299
Min. Negotiated Rate	$26,024.80
Max. Negotiated Rate	$26,024.80
Rate for Payer: Hawaii Medical Service Association Commercial	$26,024.80

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$18,060.92

Service Code	MSDRG 301
Min. Negotiated Rate	$18,060.92
Max. Negotiated Rate	$18,060.92
Rate for Payer: Hawaii Medical Service Association Commercial	$18,060.92

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$53,400.61

Service Code	MSDRG 336
Min. Negotiated Rate	$53,400.61
Max. Negotiated Rate	$53,400.61
Rate for Payer: Hawaii Medical Service Association Commercial	$53,400.61

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$60,416.40

Service Code	MSDRG 335
Min. Negotiated Rate	$60,416.40
Max. Negotiated Rate	$60,416.40
Rate for Payer: Hawaii Medical Service Association Commercial	$60,416.40

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$32,779.87

Service Code	MSDRG 337
Min. Negotiated Rate	$32,779.87
Max. Negotiated Rate	$32,779.87
Rate for Payer: Hawaii Medical Service Association Commercial	$32,779.87

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$798.00
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$882.00
Rate for Payer: Hawaii Medical Service Association Medicare	$798.00
Rate for Payer: Hawaii Western Management Group Commercial	$997.50
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$798.00
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$798.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$798.00
Rate for Payer: Ohana Health Plan Medicare	$798.00
Rate for Payer: UnitedHealthcare Medicare	$798.00
Rate for Payer: University Health Alliance Commercial	$765.35

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$53,519.12

Service Code	MSDRG 243
Min. Negotiated Rate	$53,519.12
Max. Negotiated Rate	$53,519.12
Rate for Payer: Hawaii Medical Service Association Commercial	$53,519.12

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$71,580.04

Service Code	MSDRG 242
Min. Negotiated Rate	$71,580.04
Max. Negotiated Rate	$71,580.04
Rate for Payer: Hawaii Medical Service Association Commercial	$71,580.04

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$43,967.21

Service Code	MSDRG 244
Min. Negotiated Rate	$43,967.21
Max. Negotiated Rate	$43,967.21
Rate for Payer: Hawaii Medical Service Association Commercial	$43,967.21

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
Hospital Revenue Code	637
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

PERMETHRIN 5% CREAM (ELIMITE) (60 GRAM) (TAKE HOME) [4080388]

Facility

$15.00

Service Code	NDC 00004080176
Hospital Revenue Code	253
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

PERMETHRIN 5% CREAM (ELIMITE) (60 GRAM) (TAKE HOME) [4080388]

Facility

$15.00

Service Code	NDC 00004080176
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

PERMETHRIN 5 % TOPICAL CREAM [10917]

Facility

$414.00

Service Code	NDC 21922002107
Hospital Revenue Code	250
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$248.40
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: Kaiser Permanente Commercial	$372.60
Rate for Payer: MDX Hawaii PPO	$401.58

PERMETHRIN 5 % TOPICAL CREAM [10917]

Facility

$414.00

Service Code	NDC 21922002107
Hospital Revenue Code	637
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$401.58
Rate for Payer: AlohaCare Medicaid	$207.00
Rate for Payer: AlohaCare Medicare	$314.64
Rate for Payer: Cash Price	$248.40
Rate for Payer: Devoted Health Medicare	$347.76
Rate for Payer: Hawaii Medical Service Association Medicare	$314.64
Rate for Payer: Hawaii Western Management Group Commercial	$393.30
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: Humana Medicare	$314.64
Rate for Payer: Kaiser Permanente Commercial	$372.60
Rate for Payer: Kaiser Permanente Medicaid	$211.14
Rate for Payer: Kaiser Permanente Medicare	$314.64
Rate for Payer: MDX Hawaii PPO	$401.58
Rate for Payer: Ohana Health Plan Medicaid	$314.64
Rate for Payer: Ohana Health Plan Medicare	$314.64
Rate for Payer: UnitedHealthcare Medicare	$314.64
Rate for Payer: University Health Alliance Commercial	$301.76

PERPHENAZINE 2 MG TABLET [6157]

Facility

$7.00

Service Code	NDC 64980029001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

PERSONA 10MM 42-5282-009-10

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA 10MM 42-5282-009-10

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$1,915.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$2,116.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,915.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$1,915.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$1,915.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$1,915.20
Rate for Payer: Ohana Health Plan Medicare	$1,915.20
Rate for Payer: UnitedHealthcare Medicare	$1,915.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA FEM CMT CCR NRW SZ10 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ10 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ10 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,700.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$4,104.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$4,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,104.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$4,104.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$4,104.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$4,104.00
Rate for Payer: Ohana Health Plan Medicare	$4,104.00
Rate for Payer: UnitedHealthcare Medicare	$4,104.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

Know your out-of-pocket cost for care.

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